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Doctors’ Roles in Prescription Drug Abuse

Since 1999 and 2010, the number of opioid painkiller prescriptions written in the United States tripled. Over the same time period, deaths caused by drug overdose rose almost 500 percent. Many of these deaths result from prescription overdose. Research suggests doctors are not always following guidelines for monitoring potential prescription drug abuse, including maintaining patients on opioid medication for long periods of time. Further complicating the matter is the fact that guidelines for opioid prescriptions vary from state to state. It’s easy to lay the blame for prescription painkiller addiction at doctors’ doors, but doing so obscures the complexity of prescription drug abuse. It helps to understand why opioid prescription use skyrocketed since the 1990s.

Oligoanalgesia in the 1990s Throughout the late 1980s and into the 1990s, the medical community struggled with the problem of oligoanalgesia — the under-treatment of pain. Patients were not receiving sufficient treatment to relieve pain. This was a serious problem, and efforts were made to address the oversight. Opioids were considered safer for acute pain than large doses of non-steroid analgesics, which can cause serious gastrointestinal complications. At the same time, according to a Time magazine viewpoint article written by Doctors Zachery Meisel and Jeanmarie Perrone, med students were often taught patients would not become dependent on opioids when prescribed for legitimate pain. This, of course, proved completely untrue. So, opioid use increased out of the real need for more effective pain treatment. Unfortunately, we’ve swung too far in the opposite direction. Instead of under-treating pain, now we’re over-treating it.

A Vicious Cycle Long-term use of opioid painkillers increases tolerance, which causes the patient to require higher and higher doses in order to achieve pain relief. This also increases the risk of addiction and eventual drug abuse rehab. Additionally, opioid use can cause hyperalgesia, a hypersensitivity to new pain. Many people’s response to new pain is to take more painkillers, with or without their doctor’s consent. Easy availability of opioids has led many people, especially kids, to experiment with painkiller abuse. Sneaking a few pills out of the family medicine cabinet seems less dangerous than buying street drugs, and all too often kids — and adults — assume painkillers are safe simply because they’re prescribed, further encouraging misuse. Is the problem entirely the fault of the medical community? Probably not. Prescription painkillers come with some severe warning labels, all too often ignored by patients. Certainly the medical profession needs to address over-use of opioid prescriptions, but ultimately, it falls on us as individuals to treat these powerful medications with respect. What do you think? (Photo via)

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